Is Early Treatment Making Whiplash Injuries Worse?Is it possible to get too much medical help too soon after a whiplash injury? That's the question posed by the authors of this article. By examining the results of studies reporting results of early treatment for whiplash, they found a surprising amount of evidence that iatrogenic disability is possible.
Iatrogenic disability refers to the development of problems caused by the treatment. Chronic pain is one of those problems. Studies consistently showed that too much treatment too soon actually increases the risk of chronic pain and disability. How do they explain this finding? And what kind of "treatment" are they talking about?
First, let's look at the types of treatment studied. Fitness training, chiropractic care, and physical therapy during the early stages of recovery from whiplash were linked with slower recovery. The reason? Possibly too much attention creates illness behaviors. Calling the problem a "whiplash" injury instead of a "neck strain" may be a way health care providers cause or extend the sick-role. Not enough focus on self-care may encourage passive coping behaviors.
These findings prompt the next most logical question: how should whiplash injuries be handled early on? Efforts are made to help reduce patient's pain and improve their function towards a goal of preventing chronic whiplash-associated disorders (WADs).
There is plenty of evidence that education, home exercise, and returning to normal activities as soon as possible is the most successful approach to this problem. Reducing patients' fear and anxiety about their condition seems to be a big help (and more successful than other hands-on treatments).
Many people wonder whether or not they should wear one of those soft neck collars after the accident. Others are quick to visit their chiropractor. The fact is a one-hour education session focused on fear reduction and staying active outperformed specialized exercises (McKenzie exercises) or wearing a collar.
And more than six visits to the chiropractor lengthened the time to recovery when compared with patients who did not see a chiropractor. Several studies did support the use of neck mobilization exercises provided by physical therapists. The exercise program was done at home by the patients.
All of these findings are the same thing the special Neck Pain Task Force has been recommending for years. Early treatment of whiplash with rest, soft collars, heat, cold, or exercise just isn't evidence-based. Other approaches such as steroid injections, traction, and medications haven't been studied enough to know for sure if they help or hurt recovery.
The authors say the bottom-line is that health care providers need to pay attention to the evidence and stop providing treatments that have been proven ineffective for whiplash. They say whiplash is a fairly benign problem that requires prevention management. Education, reassurance, and encouragement to get back to normal daily living is the number one effective approach to whiplash injuries.
Pierre CÃ´tÃ©, DC, PhD, and Sophie Soklaridis, PhD. Does Early Management of Whiplash-Associated Disorders Assist or Impede Recovery? In Spine. December 1, 2011. Vol. 36. No. 25S. Pp. S275-279.
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